Gastric pull-up in hypopharyngeal and cervical esophageal cancers

Yıl 2002, Cilt: 9 Sayı: 5, 363 - 367, 10.10.2002

E. Evrim Ünsal Şafak Dağlı Osman Arıkan Cafer Özdem

Öz

Objectives: Gastric pull-up is a common technique in the reconstruction of gastrointestinal continuity follovving surgery for the primary esophageal and hypopharyngeal tumors with involvement of the esophagus. We evaluated the results of surgery in patients with cervical esophageal and hypopharyngeal cancers.Pati ents and Methods: Eleven patients 4 women, 7 men; mean age 46 years; range 18 to 70 years unden/vent surgery for hypopharyngeal and cervical esophageal epidermoid carcinoma. Surgery included pharyngolaryngoesophagec- tomy, subtotal thyroidectomy, and gastric pull-up in ali patients. İn addition, nine patients had radical neck dissection on the involved side and modified radical neck dissec- tion on the contralateral side. One patient had bilateral rad­ical neck dissection. Patients who were alive were follovved- up for a mean period of 27 months range 14 to 46 months .Results: The one-, two-, and three-year survival rates were 54% 6/11 , 36% 4/11 and 18% 2/11 , respectively. Three patients died from early postoperative complications, two from organ failure due to locoregional recurrence 7th month and to distant metastasis 11 th month .Conclusion: Despite the small size of the study, the results favor the use of gastric pull-up in selected patients with cervical esophageal and hypopharyngeal cancers.

Anahtar Kelimeler

Carcinoma, squamous cell/surgery, esophageal neoplasms/surgery, esophagectomy, hypopharyngeal neoplasms/ surgery, laryngectomy, pharyngectomy, postoperative complications, prognosis, stomach/surgery/transplantation, survival rate

Hipofarenks ve servikal özofagus kanserlerinde gastrik pull-up

Öz

Am a ç : Gastrik pull-up, primer özofagus ve özofagusa ya- yılan hipofarenks tümörlerinde, gastrointesinal sistemin devamlılığının sağlanmasında sık kullanılan bir rekonst- rüksiyon tekniğidir. Çalıflmamızda, hipofarenks ve servi- kal özofagus kanseri nedeniyle ameliyat edilen hastalar- da bu tekniğin sonuçları değerlendirildi. Hastalar ve Yöntemler: Hipofarenks ve servikal özofa- gus epidermoid kanseri nedeniyle ameliyat edilen 11 hasta ça- lıflmaya alındı. Tüm hastalara farengolarengoözofajek- tomi, subtotal tiroidektomi ve gastrik pull-up ameliyatı yapıldı. Aynı seansta, dokuz hastaya lezyon tarafına radikal boyun diseksiyonu, diğer tarafa modifiye radikal boyun diseksiyonu, bir hastaya da iki taraflı radikal bo- yun diseksiyonu uygulandı. Hayatta kalan hastalar or- talama 27 ay dağılım 14-46 ay süreyle izlendi. Bu l g u l a r : Sağkalım oranları bir yıl için %54 6/11 , iki yıl için %36 4/11 , üç yıl için %18 2/11 bulundu. Üç hasta ameliyat sonrasında geliflen komplikasyonlar, bir hasta lokorejyonel nüks 7. ay , biri de uzak metas- taza bağlı organ yetmezliği 11. ay nedeniyle yaflamı- nı yitirdi. Sonu ç : Sınırlı hasta sayısına rağmen, gastrik pull-up tek- niğinin uygun seçilmifl olgularda fonksiyonel sonuçları iyi olan, güvenilir bir rekonstrüksiyon yolu olduğunu düflünü- y o r u z

Anahtar Kelimeler

Karsinom, skuamöz hücreli/cerrahi, özofajeal neoplazmlar/cerrahi, özofajektomi, hipofarenjeal neoplazmlar/cerrahi, larenjektomi, farenjektomi, ameliyat sonrası komplikasyon, prognoz, mide/cerrahi/transplantasyon, sağkalım oranı

Kaynakça

• Jones AS, Roland NJ, Hamilton J, Rowley H, Nandapalan V. Malignant tumours of the cervical oesophagus. Clin Otolaryngol 1996;21:49-53.
• Collin CF, Spiro RH. Carcinoma of the cervical esoph- agus: changing therapeutic trends. Am J Surg 1984;148: 460-6.
• Ong GB, Lee TC. Pharyngogastric anastomosis after esophago-pharyngectomy for carcinoma of the hypopharynx and cervical esophagus. Br J Surg 1960; 48:193-200.
• Le Quesne LP, Ranger D. Pharyngolaryngectomy, with immediate pharyngogastric anastomosis. Br J Surg 1966; 5 3 : 1 0 5 - 9 .
• Spiro RH, Bains MS, Shah JP, Strong EW. Gastric trans- position for head and neck cancer: a critical update. Am J Surg 1991;162:348-52.
• S p i ro RH, Shah JP, Strong EW, Gerold FP, Bains MS. Gastric transposition in head and neck surg e r y. Indications, complications, and expectations. Am J Surg 1 9 8 3 ; 1 4 6 : 4 8 3 - 7 .
• Stepnick DW, Hayden RE. Options for reconstruction of the pharyngoesophageal defect. Otolaryngol Clin North Am 1994;27:1151-8.
• Güldiken Y, Veyseller B, Hafız G, Biliciler N, Baflerer N, Kıyak E, ve ark. Bafl-boyun defektlerinde rekon- strüksiyon yöntemleri. Kulak Burun Bogaz Ihtis Derg 1997;4:76-80.
• Laterza E, Mosciaro O, Urso US, Inaspettato G, Cordiano C. Primary carcinoma of the hypopharynx and cervical esophagus: evolution of surgical therapy. Hepatogastroenterology 1994;41:278-82.
• Hartley BE, Bottrill ID, Howard DJ. A third decade's experience with the gastric pull-up operation for hypopharyngeal carcinoma: changing patterns of use. J Laryngol Otol 1999;113:241-3.
• Bussi M, Ferre ro V, Riontino E, Gasparri G, Camandona M, Cortesina G. Problems in reconstruc- tive surgery in the treatment of carcinoma of the hypopharyngoesophageal junction. J Surg Oncol 2000; 74:130-3.
• Polotsky BE, Machaladze ZO, al-Ansary NM. Some aspects of multiple esophageal and gastric cancer. Semin Surg Oncol 1992;8:46-9.
• Sasaki CT, Salzer SJ, Cahow E, Son Y, Wa rd B. Laryngopharyngoesophagectomy for advanced hypopharyngeal and esophageal squamous cell carci- noma: the Yale experience. Laryngoscope 1995;105: 160-3.
• Gunnlaugsson GH, Wychulis AR, Roland C, Ellis FH Jr. Analysis of the records of 1,657 patients with carci- noma of the esophagus and cardia of the stomach. Surg Gynecol Obstet 1970;130:997-1005.
• Pearson JG. Radiotherapy for esophageal carcinoma. World J Surg 1981;5:489-97.
• Mendenhall WM, Parsons JT, Vogel SB, Cassisi NJ, Million RR. Carcinoma of the cervical esophagus t reated with radiation therapy. Laryngoscope 1988; 9 8 : 7 6 9 - 7 1 .
• Peracchia A, Bardini R, Ruol A, Segalin A, Castoro C, Asolati M, et al. Surgical management of carcinoma of the hypopharynx and cervical esophagus. Hepatogastroenterology 1990;37:371-5.